Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation - Impact of different catheter technologies

被引:308
作者
Marrouche, NF
Dresing, T
Cole, C
Bash, D
Saad, E
Balaban, K
Pavia, SV
Schweikert, R
Saliba, W
Abdul-Karim, A
Pisano, E
Fanelli, R
Tchou, P
Natale, A
机构
[1] Cleveland Clin Fdn, Dept Cardiol, Electrophysiol Lab, Sect Pacing & Electrophysiol, Cleveland, OH 44195 USA
[2] Casa Sollievo Sofferenza, Foggia, Italy
关键词
D O I
10.1016/S0735-1097(02)01972-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES We conducted this study to compare the efficacy and safety of different catheter ablation technologies and of distal versus ostial pulmonary veins (PV) isolation using the circular mapping technique. BACKGROUND Electrical isolation of the PVs in patients with atrial fibrillation (AF) remains a technical challenge. METHODS Two hundred eleven patients (163 men; mean age 53 +/- 11 years) with symptomatic AF were included in this study. In the first 21 patients (group 1), distal isolation (greater than or equal to5 mm from the ostium) was achieved targeting veins triggering AF. In the remaining 190 patients (group 2), ostial isolation of all PVs was performed using 4-mm tip (47 patients), 8-mm tip (21 patients), or cooled-tip (122 patients) ablation catheters. RESULTS Distal isolation was able to eliminate premature atrial contractions (PACs) and AF in six of 21 patients (29%) and 10 of 34 PVs. After a mean follow-up time of 6 +/- 4 months, no patients treated with the 8-mm tip catheter experienced recurrence of AF, whereas 21% (10 of 47 patients) and 15% (18 of 122 patients) of the patients ablated with the 4-mm tip and the cooled-tip ablation catheters experienced recurrence of AF after a mean follow-up of 10 3 and 4 +/- 2 months, respectively. Significant complications including stroke, tamponade, and severe stenosis occurred in 3.5% (8/211) of patients. CONCLUSIONS Catheter technologies designed to achieve better lesion size appeared to have a positive impact on procedure time, fluoroscopy time, number of lesions, and overall efficacy. Although distal isolation can be achieved with fewer lesions, ostial isolation is required in the majority of patients to eliminate arrhythmogenic PACs and AF. (C) 2002 by the American College of Cardiology Foundation.
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页码:464 / 474
页数:11
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